At 67 kg with a body mass index (BMI) of 30 kg/m2, a 45-year-old woman certainly does not fall under the category of ‘severe obesity’. However, with a new grading system which takes into account her severe metabolic, functional and psychological disabilities, the woman would be termed a Grade 3 or “severely obese patient”. She would also require aggressive treatment, says Dr Shashank Shah. Dr Shah, a noted bariatric surgeon, and Prof Dr Neeta Deshpande, endocrinologist and obesity physician, have co-authored a recently-published paper in the Journal of the Association of Physicians of India about new obesity guidelines based on associated conditions and not BMI alone where they have made the observations. Dr Shah and several other experts have called for immediate action and implementation of the guidelines by all medical experts and associations of the medical fraternity. Dr Shah, who is also the former president of Obesity and Metabolic Surgery Society of India, said, “This woman is a classic example of why this kind of grading of obesity is important, as we see many patients with diabetes with a lower weight. She had severe diabetes, neuropathy, sleep apnea, severe joint pain and osteoarthritis of both the knee joints limiting her daily activities because of pain.” He added, “She had breathlessness, was on insulin and her relationship with her husband had also been disturbed so she was emotionally extremely depressed. This woman underwent surgery when diabetes and issues like breathlessness were under control. She started living a normal life, her functional capacity increased, psychological confidence and metabolic disorders also improved. Such patients require more appropriate and more aggressive treatment and this guideline would do justice to people, who otherwise are not considered severely obese.” Bariatric surgery is the last resort for those battling obesity when diet and exercise fail. Dr Shah pointed out that it is important to follow the updated bariatric surgery guidelines to determine eligibility for the procedure. According to the guidelines, the people eligible for bariatric surgery include those with a BMI of over 35 kg/m2 with or without any comorbidities related to obesity, BMI above 32.5 kg/m2 with more than one comorbidity related to obesity, BMI of over 30 kg/m2 with more than two comorbidities related to obesity and BMI of over 27.5 kg/m2 with uncontrolled Type 2 diabetes despite treatment. Obesity is the accumulation of excess body fat to the extent that it presents a health risk. According to a recent nationwide cross-sectional study that evaluated data from 1,00,531 adults in a randomised cluster sample across India, the prevalence of obesity in the country is 40.3 per cent, with a higher incidence among women, urban populations and individuals aged over 40 years. Parallel to the increasing obesity rates, the burden of diabetes is also high and increasing globally, mainly fuelled by unhealthy lifestyles. Estimates from 2019 showed that 77 million individuals had diabetes in India and this number is expected to rise to over 134 million by 2045, with approximately 57 per cent of these individuals remaining undiagnosed. “At the international level, these new guidelines have already been implemented and treatment of obesity is based on associated problems and we will be speaking about this again at the third world congress of cardiometabolic medicine at Mumbai,” Dr Shah said, adding that awareness would be stepped up among primary care physicians on the need to rethink what defines severe obesity.
